EDITOR’S NOTE: On Tuesday of this week, news media organizations were reporting that U.S. intelligence officials delivered a report to both President Barack Obama and President-Elect Donald Trump outlining allegations that the Russians could have compromising information on him. The news came on the heels of a report on Russian hacking of email servers of the Democratic National Committee in the run-up to the presidential election, in what many are viewing as cyberwarfare.
It’s a nightmare scenario for any hospital: suddenly, all computer screens are stuck on a warning message indicating that “all of your data has been encrypted. In order to unlock access to your system, you must pay $250,000 in Bitcoin.”
Immediately, the entire hospital is plunged into a crisis. It is impossible for staff to look up patient conditions or determine what treatments are required. Lives of patients are threatened. The IT group has no idea what to do. This is the threat of so-called “ransomware” – valuable data being kidnapped until a ransom is paid.
Why do cyber-extortionists use Bitcoin? And what is Bitcoin?
It’s a cryptocurrency, or decentralized digital currency. It relies on a peer-to-peer system, which means there is no central point of control. It is open source software, so no company owns or controls Bitcoin. There is no intermediary for moving the currency from one party to another, no records, no taxes to pay, and no way to identify the party receiving the payment.
All Bitcoin transactions are recorded in a giant ledger that is distributed from one network node to another. This ledger is called the “blockchain.” There are Bitcoin ATMs. The amount of Bitcoin currently in circulation is worth well over $10 billion. In 2015, the British bank Barclays announced it will accept Bitcoin. The price changes, but in November 2015, one Bitcoin was the equivalent of around $500. But again, there is no central repository, like a central bank (Federal Reserve), and no one controls the currency supply.
Bitcoin is a viable currency, and it is accepted for payment by many vendors. But it also is a favorite of criminals because there is no record of its use or transfer, no tracking, and of course, again, no taxes. According to the FBI, “criminals prefer Bitcoin because it’s easy to use, fast, publicly available, decentralized, and provides a sense of heightened security/anonymity.”
Ransomware
Ransomware, or “cyber extortion,” is said to have originated in Eastern Europe in 2005. The scourge of ransomware is spreading rapidly. In the United States, attacks are expected to top $1 billion in 2016. But these estimates probably ignore the vast majority of ransomware attacks that never are reported. According to the FBI, a typical ransomware payment is between $200 and $10,000. By early 2016, there were more than 4,000 reported ransomware attacks. The current rate is around 3,000 attacks per day. It is big business.
The names of ransomware programs read like a twisted hacker’s nightmare: CryptoWall, CTB-Locker, TeslkaCrypt, Samoas (SAMSAM), Locky (very popular), Conflickeer work, Chanitor, Nivdort bot, HummingBad, Triada, Ztorg, GameOverZeus, etc. The Android OS is particularly vulnerable. There are a few groups of cyber extortionists known for exploiting ransomware. These include the so-called Cyber Caliphate Army (CCA) and the Brazil-based TeamXRat. But there is need to worry about these specific groups, because you will never know who hit you. Table 1 summarizes a few of recent ransomware attacks against hospitals.
|
Table 1 — Examples of 2016 Ransomware Attacks on Hospitals |
|
||
|
Hospital |
Date |
Incident |
|
|
Keck Hospital (University of Southern California) |
Aug. 1, 2016 |
Attack was contained and isolated. No ransom paid. Electronic medical record system not attacked. Operational documents were target. |
|
|
Norris Hospital (University of Southern California) |
|||
|
Hollywood Presbyterian Medical Center, California |
Feb. 15, 2016 |
$3.4 million demanded. Information systems were offline for a week. Paid out $17,000. Malware introduced with phishing attack. |
|
|
Marin General Hospital |
July. 11-26, 2016 |
Ransom paid. Nine medical centers affected. Vital signs, limited clinical history, documentation of physical examinations, and all records between patients and their physicians were lost. |
|
|
Hugh Chatham Memorial Hospital |
Sept. 25, 2016 |
Ransomware attack failed. Hospital able to recover from backup. |
|
|
MedStar Health (Columbia, Md.) |
March 28, 2016 |
$19,000 demanded. Hospital refused to pay. Forced to revert to paper system during outage. Patient numbers reduced at its 10 hospitals and 250 outpatient centers. |
|
|
Prime Healthcare (Desert Valley Hospital, Chino Valley Medical Center, Alvarado Hospital Medical Center) |
Jan. 20, 2016 |
Systems down for several days. Hospitals were able to recover without paying. |
|
|
Rainbow Children’s Clinic |
August 2016 |
Lost patients’ names, addresses, dates of birth, Social Security numbers, medical information, payment guarantors. Payment not reported.` |
|
|
Methodist Hospital (Henderson, Ky.) |
March 25, 2016 |
Reported payment of $17,000 or much more. |
|
|
Source: Barraclough NY LLC analysis. |
|||
How Hospitals Can Protect Against Ransomware
Unlike financial institutions, hospitals in general do not have a great degree of experience in handling computer emergencies. Even though healthcare represents a large part of the economy, spending on cybersecurity is less than 10 percent of overall security spending. In other words, the healthcare sector is under-investing in security. And this needs to change.
There are a number of steps hospitals can take to improve their defenses against ransomware. Any hospital might start with a ransomware audit. This audit would aim at developing a strategy or “playbook” to improve network security, help educate healthcare employees on good security practices, put in place a computer recovery plan, and develop a protocol to handle emergencies. A few options to consider are summarized in Table 2.
|
Table 2 — Barraclough’s Best Practices for Hospitals Facing the Threat of Ransomware |
|
|
Internal Audit. |
Put up Walls. |
|
No Internet Email. |
Notification Procedures. Have in place a notification procedure in case patient records are compromised. This includes having a legal team on standby. |
|
The Playbook. Create a “crisis playbook” that defines key roles and activities in case of a ransomware incident. Rehearse this playbook in a live simulation every two months. |
Mirror IT System. |
|
Have Paper Backup Available. |
Law Enforcement Liaison. Have pre-arranged contacts with law enforcement, both state and federal. Establish single point of contact in your institution. Ensure these persons know the law enforcement contacts on a professional basis. |
|
Evidence Logging. Train IT professionals and others to keep an “evidence log” so that all information regarding the ransomware crime is logged. Avoid erasing evidence when you restore your system. |
Universal IT Security Training. Institute IT security training for every single employee. Use online training. Build successful IT training into annual performance reviews to ensure everyone is trained. |
|
Source: Barraclough NY LLC. This table: © 2016, Barraclough NY LLC, All Rights Reserved. For more information on ransomware audits, see http://www.barracloughllc.com |
|
It is important to note that ransomware is not only an IT issue. There are important legal considerations. For example, if patient records are compromised, the healthcare provider must make notification. And this means that as many as tens of thousands of persons must be contacted, and in a timely manner.
No matter what measures a hospital takes against cyber-extortionists, the reality is that it is impossible to have 100-percent reliable protection against hackers. But there is much that can be done to a) lower the chances of being hacked; and b) ensure that if a ransomware incident takes place, it can be dealt with expeditiously and with the least harmful disruption to what is really important: helping patients.
Program Note
RACmonitor presents a live webcast, “Protect Your Facility from Cyberattacks: Learn from Real World Examples,” Tuesday, Jan. 17, 1:30 p.m. ET
Please log in to your account to comment on this article.
Dr. Ronald Hirsch provides tried-and-true strategies and insight into outpatient in hospital bed stays including determining the applicable definition, who uses it, and when and how to bill for this circumstance, solidified with concrete case examples and expert insight.
Practical solutions for CDM departments to protect your hospital’s revenue.
This webcast teaches hospitals how to comply with CMS price transparency rules and compare their rates with peer hospitals. It covers creating a compliant machine-readable file, comparing negotiated rates, and improving pricing decisions.
The No Surprises Act (NSA) presents a challenge for hospitals and providers who must provide Good Faith Estimates (GFEs) for all schedulable services for self-pay and uninsured patients. Compliance is necessary, but few hospitals have been able to fully comply with the requirements despite being a year into the NSA. This webcast provides an overview of the NSA/GFE policy, its impact, and a step-by-step process to adhere to the requirements and avoid non-compliance penalties.
This expert-guided webcast will showcase tips for providers to ensure appropriate capture of the work performed for a visit. Comprehensive examples will be given that demonstrate documentation gaps and how to educate providers on the documentation necessary to appropriately assign a level of service. You will gain clarification on answers regarding emergency department and urgent care coding circumstances as well as a review of how/when it is appropriate to code for E&M in radiology and more.
Set yourself up for financial and compliance success with expert guidance that breaks down the impactful changes including MS-DRG methodology, surgical hierarchy updates, and many new technology add-on payments (NTAPs). Identify areas of potential challenge ahead of time and master solutions for all 2024 Proposed IPPS changes.
Do you struggle with selecting and appending the correct modifier for your medical claims? Join our must-attend webinar, “Mastering Modifier Usage: Preventing Denials and Ensuring Compliance” to reduce claim denials and improve your reimbursement rates.
Kay Piper reviews the guidance and updates coders and CDISs on important information in the AHA’s fourth quarter 2023 ICD-10-CM/PCS Quarterly Coding Clinic in an easy to access on-demand webcast.
Copyright © 2022 RACmonitor. Powered by MedLearn Media.
